1 - mental health

• • Mental disorders = 7th leading cause of ‘years lost to disability’
• Depression then anxiety = disorders with most years lost to disability globally
• 'Treatment gap' = gap between need for treatment and its provision
• Proportion who received treatment in the UK:

  35% moderaltely sever cases
• Proportion who receieved treatment in the previous 12 months:

  11% severe in China

  21% severe in Nigeria

  59% of severe in USA
• Depression, schizophrenia, bipolar disorder + alcohol use disorder are top 10 causes of health related disability in low income countries
• LMIC (low middle income countries) barriers to access MH care

  • lack of services and shortage of resources
  • shortage of trained workforce
  • financial cost to families
  • perceived barriers to help-seeking e.g. no need for care, stigma
• HIC (high income countries) barriers to access MH care

  • increased uptake of treatment for MH since 1990 (1 in 3 receive treatment in UK)
  • Treatment still not up to standard
  • Not reaching those who need it most due to perceived barriers
• Stigma = someone views the individual affected by MH in a negative way because of it
• Discrimination = someone treats individual in a negative way because of MH
• MH stigma = 'double jeopardy' for individuals affected - leads to reluctance to seek help
• Internalised/self stigma

  • emotionally/cognitively absorbing the negative beliefs about the self
  • based on shame/accepting stereotypes
• Public stigma

  • Ignorance/prejudice by family/friends leads to discrimination, exclusion, difficulty accessing care
• Structural stigma

  • Laws, policies and practices result in unfair treatment of people with lived/living experience
  • professionals contribute through conscious/unconscious biases
• Beliefs about mental health affecting help seeking
• Spirituality/religion

  • attributing MH to spiritual cause + seeking guidance instead of care
• emotional expression

  • perceiving that lack of emotional balance leads to MH difficulties which may get worse by talking about issue
• Shame

  • MH as a weakness of character or personality flaw
• MH intervention = methods of:

  • providing treatment and support to people experiencing MH difficulties
  • reducing risk of MH difficulties, building resilience + establish supportive environments
• Mzraek + Haggerty 1994 - model of the spectrum of interventions for MH

  
• Types of intervention:

  • Pre-emptive (prior to treatment)
  • universal - for all in a given society
  • 'At risk group'/selective - focused on groups at risk
  • At risk/indicated - sub-clinical, 'at risk' state
• Social-ecological model for MH intervention

  • interventions implemented at diff/multiple levels
  • higher level implementation can influence outcomes at the lower levels
  • psychologists can be involved at all levels
• Evidence-based interventions

  • Psychotherapeutic modalities + other techniques shown to be effective
  • Primarily randomised controlled trials (RCTs)
  • Meta-analyses of RCTs
  • Evidence base relates to a specific mental disorder, often degree of severity, sometimes specific to groups
• Evidence-based interventions

  • Maintains a standard and professional shared understanding in technique/vocab
  • critical part of profesh standards
  • unfortunately practice irl is not carefully based on evidence
• Evidence-based interventions

  • Governments + health insurance companies have developed clinical guidelines, considering both evidence AND cost
  • e.g. NICE
• NICE = National Institute for Clinical health and Excellence
• Evidence-based Practice

  • must consider clinical characteristics (e.g. severity), past experience with treatment, client preferences
• Evidence-based practice

  • Barrier:
  • evidence base is underdeveloped
  • minorities not well represented in RCTs so validity of EBI for certain groups is unclear
• IAPT = Improving Access to Psychological Therapies
• MH Services in the UK

  • structured around primary, secondary and tertiary care in the NHS
• MH Services in the UK

  • IAPT = programme of service delivery launched in 2008 to provide access to treatment for common MH disorders
• MH Services in the UK

  • IAPT:
  • uses stepped-care model to improve access to treatment
  • provides evidence-based psychological intervention, defined by level of need + therapist input
  • Addresses greatest population need i.e. very severe disorders are treated by secondary/tertiary MH services
• IAPT

  • Stepped-care model:
  • primary care = GP
• IAPT

  • Stepped-care model:
  • Low intensity service =
  • mild/moderate depression/anxiety, sleep problems, social anxiety
  • psychological well-being practitioners
  • guided self-help, computerised CBT and group-physical activity programmes
• IAPT

  • Stepped-care model:
  • High intensity service:
  • Moderate/severe depression/anxiety, OCD, social anxiety, phobias, PTSD
  • CBT/high intensity therapists
  • Weekly face-to-face sessions with trained therapist including CBT, EMDR, counselling, interpersonal psychotherapy interventions (IPT)
• IAPT

  • Stepped-care model:
  • Highly specialist:
  • severe/recurrent disorders, complex trauma, personality disorders, if other treatment unsuccessful
  • Senior CBT therapists and highly qualified specialists
• Benefits of IAPT

  • decreased waiting time
  • client's condition improved (58% to 67%)
  • recovery improved (43% to 51%)
• Criticisms of IAPT

  • only 1/2 of referred patients get treatment
  • unclear if interventions are tailored enough to meet complexity of clientele
  • unclear if IAPT prevents need for onward referral to secondary care
• Amos et al (2018) - experiences of low intensity interventions

  • 8 participants who had recieved low intensity intervention (3-6 sessions CBT)
  • Ppts anxiety/depression varied from mild-severe
  • Beneficial aspects:
  • time to talk, talking, normalisation, personal approach, adapting to clients needs
  • Nonbeneficial aspects:
  • Lack of time to talk, lack of personal approach